Prognosis after hepatic resection for stage IVA hepatocellular carcinoma: a need for reclassification.
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Journal: 2003/April - Annals of Surgery
ISSN: 0003-4932
Abstract:
OBJECTIVE
To evaluate whether the prognosis of the four categories of patients with hepatocellular carcinoma (HCC) classified as stage IVA in the tumor-node-metastasis (TNM) classification of the International Union Against Cancer (UICC) is homogeneous.
BACKGROUND
Hepatic resection has been proposed as the treatment of choice for patients with TNM stage IVA HCC, which consists of four different categories. It is unknown whether the prognosis of the four categories of patients is homogeneous.
METHODS
Clinicopathologic and follow-up data of 106 patients with resection of stage IVA HCC from 1989 to 2000 were prospectively collected. Survival results of the four categories of stage IVA patients were compared.
RESULTS
Among stage IVA patients, survival was significantly worse in those with tumors involving a major branch of the portal or hepatic veins than in those with tumors invading adjacent organs, bilobar multiple tumors, or perforated visceral peritoneum. There were no significant differences in survival among the latter three groups. By Cox regression analysis, invasion of the portal or hepatic veins and presence of cirrhosis were independent adverse prognostic factors of overall survival among stage IVA patients, and invasion of the portal or hepatic veins was the only significant adverse prognostic factor of disease-free survival.
CONCLUSIONS
The prognosis of the four categories of patients with stage IVA HCC under the current UICC TNM staging was not homogeneous. A refined classification of stage IV HCC is needed to take into consideration the worse prognosis associated with tumor invasion of a major branch of the portal or hepatic veins.
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Ann Surg 237(3): 376-383
PMID: 12616122

Prognosis After Hepatic Resection for Stage IVA Hepatocellular Carcinoma

From the Centre for the Study of Liver Disease, Departments of *Surgery & †Pathology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
Copyright © 2003 Lippincott Williams & Wilkins, Inc.

Abstract

Objective

To evaluate whether the prognosis of the four categories of patients with hepatocellular carcinoma (HCC) classified as stage IVA in the tumor-node-metastasis (TNM) classification of the International Union Against Cancer (UICC) is homogeneous.

Summary Background Data

Hepatic resection has been proposed as the treatment of choice for patients with TNM stage IVA HCC, which consists of four different categories. It is unknown whether the prognosis of the four categories of patients is homogeneous.

Methods

Clinicopathologic and follow-up data of 106 patients with resection of stage IVA HCC from 1989 to 2000 were prospectively collected. Survival results of the four categories of stage IVA patients were compared.

Results

Among stage IVA patients, survival was significantly worse in those with tumors involving a major branch of the portal or hepatic veins than in those with tumors invading adjacent organs, bilobar multiple tumors, or perforated visceral peritoneum. There were no significant differences in survival among the latter three groups. By Cox regression analysis, invasion of the portal or hepatic veins and presence of cirrhosis were independent adverse prognostic factors of overall survival among stage IVA patients, and invasion of the portal or hepatic veins was the only significant adverse prognostic factor of disease-free survival.

Conclusions

The prognosis of the four categories of patients with stage IVA HCC under the current UICC TNM staging was not homogeneous. A refined classification of stage IV HCC is needed to take into consideration the worse prognosis associated with tumor invasion of a major branch of the portal or hepatic veins.

Abstract

Continuous data are expressed as mean ± SD; otherwise figures indicate number of patients. HBsAg, hepatitis B surface antigen; ICG-R15, indocyanine green retention at 15 minutes; AFP, alpha-fetoprotein; TACE, transarterial chemoembolization.

* Included 21 patients with invasion of the diaphragm, 3 patients with invasion of the colon, 2 patients with invasion of the right adrenal gland, and 1 patient with invasion of the right kidney. Invasion of adjacent organs was confirmed histologically.

† Included both parenchymal involvement of the margin and venous permeation at the margin.

‡ Serum AFP levels of patients with bilobar multiple tumors were significantly lower than those of the other three groups (P < .05).

§ The proportion of patients with positive microscopic venous invasion was significantly higher in patients with macroscopic invasion of portal or hepatic veins than in the other three categories (P < .05). Otherwise there were no significant differences between any groups in any other parameters.

HBsAg, hepatitis B surface antigen; AFP, alpha-fetoprotein; TACE, transarterial chemoembolization.

* Tumor size refers to the diameter of the largest tumor.

† Multiple tumor nodules refer to any macroscopically detectable nodules, including macroscopic satellite nodules around the main tumor but not microsatellite nodules that were seen only on histologic examination.

Footnotes

Correspondence: Ronnie Tung-Ping Poon, MS, FRCS (Edin), Associate Professor, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.

E-mail: poontp@hkucc.hku.hk

Accepted for publication August 8, 2002.

Footnotes

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